The PICU is a very high-tech place — full of machinery that helps sick children breathe better, assists their hearts to beat better, and helps their kidneys do their job. The PICU room of a sick child can be stuffed with machines that flash, beep, and bing. We also have an array of monitoring devices that tell us how a child’s organs are doing. They alert us to when there are problems. They also give us evidence of when things are improving.

The interesting thing, though, is that often the first signs of improvement do not come from any of the machinery. Often an experienced eye — especially a parent’s eye — can sense that things are just better. The child simply looks better. There is no monitoring device that can replace that experienced eye.

I’ve written before about what we call Evidence-Based Medicine. The idea is that doctors shouldn’t do things for which we lack good evidence that it works. That seems like a silly notion — don’t doctors know what they’re doing? In fact, a good portion of medical practice rests upon tradition or fairly weak anecdotal evidence. This matters a lot when we’re talking about high-risk things — nobody should be subjected to risk without potential benefit. It also matters a lot when we’re talking about expensive things. Good estimates are that about a third of what doctors do helps little, if at all.

The state of Washington pays for the healthcare of about 700,000 people, and has taken the lead in trying to do transparent, out-in-the-open evaluation of some expensive medical interventions. If they don’t work, they won’t be covered. No exceptions. Most of the decisions taken thus far are for expensive surgical procedures, things that are fairly easy to assess. You can read about it here. It will be much more difficult to do this for the vast majority of situations, in which the data are more murky.

As a nation, I think we must do something like this. We certainly shouldn’t do things that don’t work. More than that, we can’t afford to keep doing so.

A child’s growth over time is a key part of pediatric care. This is true for all pediatricians, including those of us in the PICU. The most important concept is that a child keep “following the curve,” not shifting too much up or down. We use growth charts to track this, something most parents understand. Most parents also want to see their child’s chart, and many parents keep their own at home.

Thus it is important for parents to understand what the chart shows. A recent study in the journal Pediatrics, a survey of 1000 parents, showed that around half of parents misunderstood how to use them. There are some nice pictures of growth charts in the above link, but a simpler explanation is here. It’s something worth knowing about for all parents.